Why is family planning necessary today?

Population control assumes importance if one considers the fact that forty years ago the population of our country was a mere three hundred and forty million which, in 1981 had swelled to six hundred and seventy million, in 1991, increased to eight hundred and forty four million and, by the turn of the Country, may well escalate to the one billion mark! I his galloping increase have to be tackled on a war looting. The socio-economic benefits of family planning to the individual, society and nation cannot ho overemphasized. One needs to remember that Family Planning’ is ‘Family Welfare’.

Is vaginal douche after intercourse a safe method of contraception?

No. It is practiced as a method of local hygiene and not as a method of contraception.

Is Coitus interrupts a safe method of contraception?

No. Coitus interrupts involves withdrawal just prior to ejaculation so that ejaculation occurs extra vaginally. It requires repeated motivation ind a tremendous amount of will-power, during each act of coitus, to be effective. Hence, the failure rate is very high. Moreover, some men may not be able to predict the moment of inevitability every time. It also affects the response and performance as the individual is constantly under tension to withdraw at the moment of inevitability and is unable to enjoy the intimacy. This gives a tinge of mechanical sex and often leaves the partner unsatisfied.

What is Post Coital Contraception?

Post-coital contraception is the employment of a contraceptive measure after intercourse, within 48 to 72 hours of an unprotected intercourse. It is more effective when used within 24 hours.

1 Hormonal - This involves taking high doses of an estrogen (Diethyl stilboesterol — 25-50 mg/day for live days or ethinyl estradiol 0.5-5mg/day for five days) and is associated with high incidence of nausea and vomiting.

Alternatively two tablets of a combination pill (Ethinyl Ostradiol 100 micro gm and 0.5 mg levonorgestrel taken initially, followed by two more tablets after precisely twelve hours, can be given. If this type of contraceptive fails there is risk of foetal malformation. 2, IUCD — A simpler method is to introduce an IUCD, ii acceptable, especially a copper containing device.

What are the common misconceptions about ‘The Pill’?

There are women who are under the mistaken, impression that the effect of the pill lingers for many months after they have discontinued it and may lead to sterility. Some again mistakenly believe that for effective contraception a pill should be taken after each coitus while others discontinue taking the pill just because of vague symptoms of mimicking pregnancy.

Are Oral Contraceptive Pills Effective from the first cycle?

Oral contraceptive pills act by interrupting the ovulation (release of the egg), thus creating an anovulatory cycle. It takes at least one ‘pill cycle’ for anovulation to get established. Hence, during the first cycle, one must use an alternative method of contraception.

What should a woman do if she forgets to take a pill?

If the woman forgets to take the pill at the usual time and remembers the lapse on the same day, she should take the scheduled pill on the same day, as soon as she remembers it. If the woman forgets to take ‘the pill’ for one day and remembers so only on the next day, she should take two pills on that day i.e. the ‘forgotten pill’ of the previous day, in addition to the scheduled pill for the day.

If, however there is a lapse in taking pills for two consecutive days then the woman must consider herself ‘unprotected’ and adopt another method of contraception for the rest of the cycle.

What is an Oral Contraceptive Pill Contraindicated?

If the woman has a history of liver disease, abnormal liver function tests, steroid dependent cancer e.g. breast cancer, abnormal uterine/vaginal bleeding or evidence of circulatory disease including hypertension, migraine; oral contraceptive pills are contraindicated. Other contraindications include, diabetes, the first six months in the case of nursing mothers and epilepsy. However, a gynaecologist’s opinion should be sought prior to use.

Detailed information on video from youtube of functions of the female reproductive sex organs and the life-long consequences of hysterectomy, including shortened vagina, loss of physical sexual sensation, personality change, loss of creativity and vitality, bone joint and muscle pain, profound loss of energy and stamina, loss of short-term memory, blunting of emotions, reclusiveness, irritability, heart disease, and osteoporosis.

What are the different contraceptive methods available today?

Today, wide range of contraceptive methods are available and the current approach is to provide a ‘cafeteria choice’ i.e. to offer all the different methods to an individual, from which, any method may be adopted depending on individual suitability and preference.

How should a Condom be used?

Though seemingly simple, a certain protocol needs to be followed when using a condom for contraception

1. A new condom should be used for every act of coitus.
2. Condoms are available in pre-tested, pre-sterilized packs and need not be tested prior to use.
3. It is to be rolled onto the erect penis just prior to insertion. Practice of delaying and putting it on just before ejaculation should be avoided.
4. It should be removed immediately after ejaculation otherwise the penis becomes flaccid and the semen is likely to spill into the vagina.
5. For removal, it is to be held on to the base of the penis, and should be withdrawn along with the penis.
6. It may be used with some spermicidal jelly to maximize its contraceptive effect.

What is Vasectomy?

Vasectomy is a permanent method of contraception by male sterilization. It is performed under local anaesthesia. Two small one cm incisions are made on either side of the scrotum. This gives access to the spermatic cord in which the vas is lound. A small segment (one cm) of the vas is cut ind the snipped ends are tied (closed) off, so that the sperm will be unable to pass through. The incisions are then closed with an absorbable suture. This operation is simpler than the sterilization of a female. Hospitalisation is not necessary and the patient can walk back home. The procedure only affects the fertility and the virility is left intact.

In which conditions, vasectomy should not be encouraged?

Vasectomy should be postponed in cases where

1. A man is equating his masculinity with fathering of the child,
2. There are unresolved doubts and conflicts about the procedure and its outcome,
3. Local conditions where surgery becomes difficult (infection, varicocele, large hydrocele, inguinal hernia, filariasis or scar tissue from surgery).

Vasectomy should be deferred until a specialist is consulted.

Can Vasectomy help Sexual Functioning?

By removing the fear of possible pregnancy and eliminating the need for artificial aids which often impair local sensitivity, vasectomy may lead to an improvement in the sexual performance in some individuals.

How soon after Vasectomy can one resume Sexual Activity without Contraception?

Don’t count days, count the number of ejaculations. At least 10 ejaculations after vasectomy and/or two consecutive semen analysis reports need to be sperm negative. Till then, effective contraceptive methods should be used.

Is Vasectomy reversible?

Yes, but the success of the reversal operation depends upon the skill of the surgeon, the technique used at the time of sterilization, duration after which reanastomosis is performed and the technique used for reanastomosis. However even after a successful reversal operation by the best of micro-surgical techniques, a man’s chances of impregnating the female are fifty-fifty.

How can Vasectomy be made more acceptable?

Ideally, the man and his wife both should be counselled together about the surgical procedure, the operative risk and the outcome. It needs to be emphasized to the couple that the procedure is merely contraceptive and will have no effect on the man’s virility. Ligating the vas will not have any effect on sexual desire, response and performance. The orgasmic capacity, ejaculation and quantity of ejaculate all remain the same. This will remove any misconceptions that the couple may harbour about the procedure. Its advantages over other methods of contraception, such as its permanency, high success rate, only one time motivation required, absence of systemic side effects, non-impairment of local sensitivity, potential reversibility and its relative ease and safety over tubectomy should also be stressed additionally. Thus, vasectomy can be made more acceptable by education.

What is Tubectomy?

Tubectomy is a permanent method of contenception by female sterilization, involving the excision of the tubes to interrupt the passage of ova. Its contraceptive measure does not leave any residual effect on the female’s sexuality.

Is Tubectomy reversible?

Yes, Tubectomy is reversible by microsurgicat techniques, but, this is more difficult than reversal of vasectomy. The success rate depends upon the method of tubectomy and the skill of operating surgeon.

Does Tubectomy affect Estrogen Levels?

No. Ligation of the tubes merely interrupts the passage of the ova thus preventing conception. It leaves the hormonal levels unchanged and has no effect on the female sexual desire.

Is there any change in sexual enjoyment after Tubectomy?

In fact, it may enhance one’s sexuality as it offers contraception without decreasing local sensitivity, it unlike barrier contraceptives.

Does the Female Superior Position prevent pregnancy?

Alas! No!

Are there any complications after Vasectomy?

Yes, occasionally. They may be surgical, immunological or psychological. Surgical complications are the least serious. They consist of bleeding (scrotal haematoma) or infection. This usually occurs a week later.

Immunological complications are extremely rare and no cause and effect relationship is known. Psychological complications occur chiefly because of inadequate counselling prior to the operation.

What preparations should one take after Vasectomy to prevent Surgical Complications?

An athletic supporter or a tight fitting jockey type underwear should be worn for a week t help relieve swelling and to support the scrotum to relieve the discomfort. The small gauze bandages protecting the incisions should be changed every two days.

What happens to the residual sperms?

The residual spermatozoa are phagocytosed (swallowed and destroyed) by the lymphatics of the testicle and epididymis and are rapidly disposed off.

Does the male hormone (Testosterone) level go down after Vasectomy?

No. Vasectomy has no effect on testosterone levels. A study was carried out by my colleagues and myself at the Institute of Research in Reproduction (ICMR), Bombay, on 45 vasectomised males with sexual dysfunctions. The duration of vasectomy was from fourteen days to fourteen years and revealed no significant change in the testosterone levels.

Is sexual desire and potency affected by Vasectomy?

No. The testes have two varieties of cells. One variety secretes testosterone that goes directly into the blood stream and is responsible for sexual desire and potency. The sperms are produced by the other variety of cells and they pass through a tube known as the vas. Thus, tying or ligation of the vas will have no effect on desire or potency. Sex life will remain unchanged. Erections, ejaculations and pleasure at orgasm will be as before.

Do hair on the breast suggest any pathology?

It is not uncommon for a woman to have a few hairs around the areola of the breast that does not need any treatment. However, they may be removed by electrolysis by a qualified person, if one so desires.

Which positions do women prefer?

The best position would depend on the individual’s preference and the woman’s anatomy. However, in personal interrogation with more than 3,000 women, if given a choice as to which position they would prefer, 75% of them preferred the female superior position. This is perhaps because the clitoris is stimulated well and it also adds a feature of novelty.

Is it necessary to stimulate the clitoris during sexual intercourse?

Some women report that they get enough clitoral stimulation during normal sexual intercourse. Some prefer a little pressure on the clitoris with the pelvic bone. Some prefer gentle stimulation along with a little pressure. For some women intercourse is enough to reach climax, while for others additional clitoral stimulation is essential.

Do clitoral adhesions lead to inhibited sexual response?

I have yet to come across a case where clitoral adhesions have inhibited sexual response. Besides they are extremely rare.

What conditions can make women frigid?

Distraction, disturbed interpersonal relationship, anti-hypertensive drugs, tranquilisers sedatives, hypnotics and sometimes oral contraceptives can all lead to decline in sexual desire. Any pain at the time of coitus, whether it is vaginitis, pelvic infection or different uterine position, may lead to frigidity of sudden onset.

What is female circumcision?

It is a barbaric custom of female genital mutilation that varies in the extent of mutilation perpetrated. Its most disfiguring form — the Pharonic circumcision practiced in Sudan and Kenya; involves cutting off of the clitoris, labia majora and labia minora followed by close apposition of the tissue that remains leaving only a tiny hole at the bottom for the passage of urine. This severe local mutilation makes sex, a painful encounter. In its mildest form, it involves excision of the clitoris or the clitoral hood alone. It is performed due to the misconception that unless it is performed a woman will become overtly promiscuous.

Do women ejaculate?

Few women do report squirting of fluid at the time of orgasm, but this is rare. Female ejaculation is an entity that remains to be proven.